Comparative Analysis of Various Guidelines for Treatment of Severe TBI

Abstract

Various guidelines have been presented during the last 20 years for treatment of severe TBI in the adult. The Rosner protocol (Rosner et al. 1995), the Lund concept (Asgeirsson et al. 1994), the US guideline (Bullock et al. 1996), the European guideline (Maas et al. 1997) and the Addenbrooke guideline from Cambridge, England (Menon 1999). An elucidatory version of the Lund Concept was published in 2006 (Grände 2006) and the last updated version of the US guideline in 2007. All guidelines except the Lund concept can be characterized as cerebral perfusion pressure (CPP)-targeted guidelines, and especially, the US guidelines are based on meta-analytic surveys. The Lund concept can be characterized as an ICP and perfusion-targeted therapy and is mainly based on basal physiological principles for brain volume and brain perfusion regulation and also supported by experimental studies.

Little research has been performed specifically for the pediatric population, defined as 18 years of age. Treatment of children and adolescents therefore is mainly based on deductions from guidelines developed for adults. Important differences from the adult are lower blood pressure and lower peripheral resistance in the whole body including the brain. This means that perfusion is maintained at blood and CPP pressures lower than those recommended for the adult. Specific recommendations for children and adolescents are presented only by Brain Trauma Foundation (2010) and for the Lund concept (Wahlström et al. 2005; Grände 2006).